What is RSV?
What is RSV? How dangerous is it? If a child has it once, is she more likely to develop it again? How can it be prevented?Question:
Respiratory syncytial virus (RSV) is a highly contagious virus which is quite prevalent during the winter months. It is transmitted primarily by hand-to-nose, hand-to-mouth, and hand-to-eye contact. The severity of the symptoms vary depending upon the age of the child and whether he has any chronic medical problems. Because RSV is so prevalent and it may cause very serious illness in some children, it is considered the most important childhood infection of the respiratory system. Thus, a lot of research is currently being done to investigate the best way to prevent and treat this disease.
HOW DO YOU GET IT?
The virus resides in the secretions (saliva and nasal secretions) of the person who has the infection. Secretions containing the virus can be infectious for hours when left on toys, countertops, and cloth. This is the main reason why it spreads so easily in daycare settings. Thus, careful hand washing is key to limiting the infection.
WHAT ARE THE SYMPTOMS
Older Children and Adults -- Runny nose, cough, and sore throat are the usual symptoms in children over the age of two years. Much of the time, it looks like just another cold children frequently get in the winter. Adults get these same types of symptoms and may call it a flu-like illness. The symptoms last about seven to ten days. On the other hand, older children and adults may get infected and show no symptoms whatsoever. Getting the infection makes one immune to getting it again within the next few months, but this immunity wanes. Therefore, it is quite common to acquire this infection on a yearly basis although the severity of symptoms tends to lessen the more times one is infected.
Younger Children -- The younger the child, the more likely he is to have severe symptoms with this infection. The symptoms may be the same as the older children, but additional more severe ones may also occur. These include fever, wheezing, breathing fast, and a decreased ability to breathe in enough oxygen. In very young babies (usually less than one month old), there is a small risk that they may stop breathing all together. This is due to the fact that younger children tend to have this infection invade not just the upper airway (e.g. nose and throat) but also the lower airway, namely the lungs. It is this lower airway infection, called bronchiolitis, that may be dangerous to young infants.
HOW IS IT TREATED?
The mainstay of treatment involves treating the symptoms of the infection rather than the infection itself. Unfortunately, there is currently no medication that has been shown to improve the course of this illness. The body must fight the infection itself. In the past, there was hope that a drug called ribavirin would help ease the symptoms of bronchiolitis caused by RSV. However, relatively recent studies have shown this drug to not be effective. To treat the wheezing, some physicians have advocated using medications similar to the ones used in asthma. However, multiple studies have shown this to be ineffective as well. What we are left with is taking care of the basic needs of the child until the body gets rid of the virus and heals itself. Therefore, treating the symptoms involves suctioning out the secretions from the nose to allow the child to breathe easier, keeping the child well hydrated by encouraging fluids, and giving oxygen when a physician determines this to be necessary.
CAN'T THIS INFECTION BE PREVENTED?
This illness infects many thousands of children each year. The vast majority do fine with the illness, a small number have to be admitted to the hospital to be treated, and a very small but not insignificant number of children die from this disease. One would think with all this sickness, our technology would be more advanced to prevent and treat this disease better. Unfortunately, this is currently not the case, but there are a number of interventions that may make this battle easier which are right around the corner.
Vaccine -- The ultimate prevention step would be vaccination. Researchers have been hard at work trying to develop a safe and effective vaccine for RSV for more than 25 years. After a lot of setbacks, there now seems to be a lead in developing this vaccine. Early studies have proved promising, and hopefully, this vaccination will be available within the 5-10 years.
Immune Globulin -- Immunoglobulin is a fancy term for the proteins that are crucial in recognizing foreign bugs that invade our bodies. Studies have shown that giving donor immune globulin as monthly infusions during the RSV season (October-March) significantly reduces the infection rate with RSV. The problem with this strategy is that there are side effects such as fever and possible allergic reactions, the immune globulin is a blood product, so there is a very small risk of acquiring an infection such as hepatitis, and it is very expensive averaging $8,000/month for treatment. Currently, this prevention strategy is being limited to those babies at highest risk for severe complications due to infection. These would include former premature infants with subsequent lung problems and those with heart defects.Answer: